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COMMUNITY PHARMACY INTERNSHIP PROGRAM
Association of Community Pharmacists of India
Manipal College of Pharmaceutical Science, Manipal
Report Prepared By
Miss. Sameera Isukapalli IV Year B.Pharm
Manipal College of Pharmaceutical Science, Manipal
(JUNE-JULY- 2010)
Acknowledgement
Dr. Anantha Naik Nagappa
Dr. Kishore Gnana Sam
Kanav Khera
Uday Venkat Mateti
Rama M
PRESCRIPTION
Prescription is an order written by the registered medical practitioner to a registered Pharmacist
to prepare and dispense that medication order.
The standard prescription should include the patient's name, age, sex, weight and any
known drug allergy. It should include the diagnosis of the disease and a complete list of
drugs
Prescription including the dosage, frequency, instructions for use and duration.
This prescription should also bear the signature and address of the prescriber
Some of the common abbreviations used during writing of the prescription:-
OD Once daily
BD Twice daily
TID Thrice daily
QID Four times daily
OC Ointment
Tab Tablet
Cap Capsule
Inj Injection
PRESCRIPTION HANDLING
The prescription handling is the first and the basic step involved in the community and the
pharmacist
Should be very good in handling the prescription. The prescription handling involves the
following steps:-
1. Receiving the prescription
2. Checking the prescription
3. Preparing the medication
4. Medication dispensing
Receiving the prescription
The prescription should not be received with astonishment or the shock on the face so that the
patient should feel bad and makes him / her think that there is something wrong in the
prescription or he /she is suffering from some serious disease.
Checking the prescription
The Prescription should be completely checked by the pharmacist after receiving it from the
patient and before dispensing the drug. If there is any mistake in the prescription or overdose or
any other problem, then pharmacist should refer the prescriber without any hesitation. The
pharmacist should not allow to make any changes in the prescription without the order of the
prescriber.
Preparing the medication
The medication to be dispensed should be prepared by pharmacist should be done with
lot of care.
The pharmacist should use the correct weight and measures to dispense the drug
The pharmacist should not prepare a medication with the guess or approximately.
The pharmacist should not dispense the sub standard or adulterated or spurious drugs.
The pharmacist should not also dispense the schedule G, H and X drugs without the
prescription to anyone and should also not refill it without the prescription.
DRUG STORE MANAGEMENT
The drugs in the community, hospital and bulk pharmacy are stored and managed in the different
ways. The different software’s and techniques are used in the different pharmacies for the
storage and management of the drugs like Hospital Gate, Clinic Gate etc.
The drugs in community pharmacy are arranged in the order of the manufacturers name
like Cipla, Biocon, etc.
The drugs in hospital or bulk pharmacy are arranged in the alphabetical order with their
category such as antihistaminic, antitussive, cardiac, diabetic, steroids etc
The expired drugs are sent back to distributor or the stockiest one week before their
expiry.
List of the some of the drugs with their category:-
CARDIAC
ANTIBIOTICS
DIABETIC
Amlodipine Amoxicillin Acarbose
Atenolol Amikacin Glibenclamide
Nifedipine Ampicilin Glipizide
Captopril Azithramycin Gliclazide
Carvedilol Cefixime Glimepride
Clonidine Cefpodoxine Insulin
Diltiazem Ceftriaxone Metaformin
Esinopril Ciprofloxacin Miglitol
Losartan Erythromycin Pioglitazone
Propranolol Gentamycin Rosiglitazona
.
COMPUTER SKILLS
The pharmacist should have the basic computer knowledge and should also have the
enough knowledge about the use of the software.
The computer are used for handling the prescriptions, maitainence of stock, billing, drug
information web site search and for many more activities.
There are number of software’s which are being used. Eg: - Hospital Gate, Clinic Gate
etc.
These software’s are used to maintaining the records in the pharmacy and for billing.
The computer shows the data which has been entered and maintained continuously during
the purchase, stocking and sale of the drugs.
The different copies of the bills are being produce d by the computer.
For eg :- In hospital pharmacy and the community pharmacy the three copies of bills are
produced in which the one copy goes to the patient , one goes to the pharmacist who is
dispensing the drugs and one goes to the cashier
There are different software for the use of the drug information. For ex: - Micromedex,
Micro Fish etc.
These Software’s gives the complete information about the drug.
REGULATORY ISSUES
The regulatory issues to start up the community pharmacy in every country vary from each other.
The minimum requirements to start a community pharmacy in India are as follows:-
The license application form should be fully filled and submitted with the required
documents and the respective fees at the licensing authority.
The person should have diploma or degree in pharmaceutical sciences.
Minimum area of about 1000 square feet.
The refrigerator for the cold storage of drugs like vaccines, blood products.
The qualified staff members
The Vat or CST number from the local tax number.
The registered pharmacist should be present during the inspection
The inspection book should be maintained.
The expiry register should be maintained.
The drugs sold or purchased should be filed in separate files and records should be
maintained.
ETHICAL ISSUES
The pharmacist should maintain the laws and rules related to his profession in the country.
The pharmacist should maintain the code of ethics like
Name and address of the patient should be maintained
The pharmacist should not sell schedule G, H and X drugs without the prescription of
registered medical practitioner.
The license of the pharmacy should be displayed at the prominent place so that it’s
visible.
The prescriptions are to be preserved and the sold drugs should be filed.
The Expiry register should be maintained.
The pharmacist should not have the cut throat competition with his fellow pharmacist.
The pharmacist should not sell the sub standard, adulterated or spurious drugs.
The pharmacist should not do the hawking of the drugs.
The pharmacist should tell the patient about the side effects of the self medication.
The pharmacist should not give any advertisements in wrappers, news paper or journals
about the efficacy of its pharmacy.
The pharmacist should not do anything which hinders the profession of pharmacy.
The Pharmacist should adapt the better regulation such as:-Good Manufacturing
Practice(GMP), Good Laboratory Practice(GLP), Good Regulatory Practice (GRP)
PHARMACEUTICAL CARE
Pharmaceutical care is the direct interaction of the pharmacist with the patient for the purpose of
caring the patient's medication-related needs. Translated into everyday practice, pharmaceutical
care is what an individual pharmacist does when he or she
Evaluates a patient's drug-related needs
Determines whether the patient has any actual or potential drug-related problems,
Works with the patient and other healthcare professionals to design, implement and
monitor a pharmacotherapeutic plan that will resolve/prevent the problem
Effective collaborations among healthcare team: - pharmacist, patient and healthcare provider
helps in the improving patient outcomes. This increased engagement in the medication use
process requires pharmacists to undertake the assessment and evaluation of medication regimens,
monitor regimens to ensure desired outcomes, counsel to ensure optimal use of medications,
interact with healthcare providers and document care.
Principles of Pharmaceutical care
Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving
definite outcomes that improve a patient's quality of life. The outcomes of treatment are:
Cure of disease
Elimination or reduction of symptoms
Arresting/slowing disease process
Preventing a disease or symptoms.
TARGETS OF PHARMACEUTICAL CARE
Disease state management
Clinical interventions (refusal to dispense a drug, recommendation to change and/or add
a drug to patient's pharmacotherapy, dosage adjustments, etc)
Professional development
Extemporaneous pharmaceutical compounding
Health psychology
Patient care
Drug abuse prevention
Prevention of drug interaction, including drug-drug interactions or drug-food interactions
Prevention (or minimization) of adverse events
Incompatibility
Drug discovery and evaluation
Detect pharmacotherapy-related problems, such as
Patient is taking a drug which he/she does not need
Patient is taking a drug for a specific disease, other than one afflication the patient
Patient needs a drug for a specific disease, but is not receiving it
Patient is taking a drug under dose
Patient is taking drug overdose
Patient is having an adverse effect to a specific drug
Patient is suffering from a drug interaction
PATIENT COUNCELING ON HYPERTENSION
ABOUT THE DISEASE
Hypertension: The persistent elevation of blood pressure (BP) than the normal BP
120/80mmHg.TABLE 10-1
Classification of Blood Pressure in Adults
Classification Systolic (mm Hg) Diastolic (mm Hg)
Normal <120 <80
Prehypertension 120–139 80–89
Stage 1 hypertension 140–159 90–99
Stage 2 hypertension ≥160 ≥ 100
Symptoms of hypertension
Headache
Confusion
Nausea and vomiting
Drowsiness
Fatigue
Signs of hypertension
Signs of end-organ damage begin to appear, chiefly related to pathologic changes in the eye,
brain, heart, kidneys, and peripheral blood vessels.
Causes of hypertension
Sedentary lifestyle
Stress
Obesity
Salt sensitivity
Alcohol in take
Vitamin D deficiency
Certain drugs like corticosteroids, estrogens, nonsteroidal anti-inflammatory drugs (NSAIDs)
and amphetamines.
Risk factors
Stroke
Heart attack
Kidney failure
Pheochromocytoma
Cushing’s syndrome
Hyperthyroidism
Hyperparathyroidism
About the Drugs
Tab Aten 25 mg 1-0-1 (Atenolol)
It is Blockers involve decreased cardiac output through negative chronotropic and inotropic
effects on the heart and inhibition of renin release from the kidney.
U have to take this drug two times daily after beak fast and after dinner.
Side effects
Hypotension, dizziness, constipation, sexual dysfunction
Tab Amlodac 5mg 1-0-0 (Amlodipine)
It is a Calcium Channel Blockers cause relaxation of cardiac and smooth muscle by blocking
voltage sensitive calcium channels, thereby reducing the entry of extracellular calcium into cells.
Vascular smooth muscle relaxation leads to vasodilatation and a corresponding reduction in BP.
U have to take this drug two times daily after beak fast .
Side effects
Headache, dizziness , drowsiness , abdominal pain and back pain
Tab Shelcal 500 mg 0-1-0
It is a multivitamin u have to take this medicine in the afternoon after food.
LIFE STYLE MODIFICATIONS
(1) Weight reduction if overweight,
(2) Dietary sodium restriction ideally to 1.5 g/day (3.8 g/day sodium chloride),
(3) Regular aerobic physical activities like yoga, swimming and walking etc
(4) If you are having the habit of drink alcohol moderate alcohol consumption (two or fewer
drinks per day),
(5) Reduce the stress
(6) Smoking cessation
PHARMACEUTICAL EDUCATIONAL MATERIAL FOR PATIENTS
The educational material for the patients is very useful as well as help for the patient so it should
be in such a format that it should provide the useful information of drug in all respects best
possible use of drug. The pamphlets and recently audiotapes and videos have become a usual,
visible and promoted source of information for patients in general practice, in specialist
consulting rooms, and in outpatient clinics.
BP MEASURINNG APPRATUS
U CAN CHECK YOU BP IN YOUR
HOME WITH THE HELP OF THIS
APPRATUS
THESE ARE THE CAUSE
OF HYPERTENSION
DIETARY SODIUM RESTRICTION
IDEALLY TO 1.5 G/DAY (3.8 G/DAY
SODIUM CHLORIDE),
SMOKING CESSATION
-
REGULAR AEROBIC
PHYSICAL ACTIVITIES
LIKE YOGA AND
WALKING
STOP DRINKIG
IF YOU ARE HAVING THE HABIT OF DRINK
ALCOHOL MODERATE ALCOHOL CONSUMPTION
(TWO OR FEWER DRINKS PER DAY)
REDUCE THE STRESS
HAVE AN HAELTHY DIET
Drawbacks in the existing system
The profession is restricted only to the hospitals linked to a pharmacy practice school.
Regulatory framework does not recognize the need for clinical pharmacist at the national
level: There are no regulatory guidelines for having qualified clinical pharmacists in an
Indian hospital
Exodus of trained clinical pharmacists toward industry as there is almost no opportunity
in the hospital setting: As there is no recognition of the job done by the clinical
pharmacist at the regulatory level, the profession failed to create job opportunities in
hospitals for qualified clinical pharmacy postgraduates.
Students are forced to either seek jobs in industries (clinical research) or continue in
academics at times teaching subjects which are out of scope of clinical pharmacy (as not
many university hospitals have pharmacy practice school). The last option is to move to
countries where the pharmacy profession is well recognized.
The need for adding industry relevant topics in course curriculum - Dilemma of dilution
Vs evolution:
There is a widening gap between the numbers of students graduating from pharmacy
practice institutions and the number actually employed as pharmacy practitioners. There
is a need to take key steps to either create a niche for clinical pharmacy professionals in
the hospital or make them competent to take up other challenging jobs in the industry.
REPORT
A total of 50 prescriptions were analyzed during the study period, among 50 prescriptions 18
females and 32 males and most of the patients were belonging to the age group of 45-56 years. It
was found that four prescriptions had drug-drug interactions pair such as Aspirin and Warfarin,
Ranitidine and Clopidogrel, Insulin and Aspirin and Amoxicillin and Warfarin. In three
prescriptions strength is not mentioned tablet Metformin, tablet Amoxicillin and tablet Ramipril.
In two prescriptions digoxin had prescribed it is narrow therapeutic drug so there is a need of
checking the levels of the drug in the blood, otherwise it will causes serious adverse drug
reactions.
Hence there is an need of community pharmacist to improve the better patient care and safe use
of drugs